留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肾损伤标志物对肾移植受者发生DGF的早期预测价值

李峰 浦金贤 黄玉华 席启林 潘浩 赵晓俊 胡林昆

李峰, 浦金贤, 黄玉华, 等. 肾损伤标志物对肾移植受者发生DGF的早期预测价值[J]. 器官移植, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
引用本文: 李峰, 浦金贤, 黄玉华, 等. 肾损伤标志物对肾移植受者发生DGF的早期预测价值[J]. 器官移植, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
Li Feng, Pu Jinxian, Huang Yuhua, et al. Predictive value of kidney injury markers for early DGF in kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
Citation: Li Feng, Pu Jinxian, Huang Yuhua, et al. Predictive value of kidney injury markers for early DGF in kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012

肾损伤标志物对肾移植受者发生DGF的早期预测价值

doi: 10.3969/j.issn.1674-7445.2022.01.012
基金项目: 

江苏省重点研发计划面上项目 BE2020654

详细信息
    作者简介:

    李峰,男,1987年生,博士,主治医师,研究方向为泌尿外科,Email:lifengdaxia2001@163.com

    通讯作者:

    胡林昆,男,1983年生,博士,副主任医师,研究方向为泌尿外科,Email: hulinkunsz@163.com

  • 中图分类号: R617, R692

Predictive value of kidney injury markers for early DGF in kidney transplant recipients

More Information
  • 摘要:   目的  探讨血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿NGAL、血清胱抑素C(Cys-C)以及血清肌酐(Scr)预测肾移植受者发生肾功能延迟恢复(DGF)的价值。  方法  收集159肾移植受者的临床资料及血液、尿液标本,根据是否发生DGF,分为DGF组(42例)和即刻肾功能恢复(IGF)组(117例)。分析两组受者的临床资料,对比两组受者的血NGAL、尿NGAL、Cys-C及Scr变化情况,分析不同指标对DGF的早期预测价值。  结果  159例肾移植受者中,42例发生DGF,发生率为26.4%。两组供者年龄、供肾冷缺血时间及补体依赖淋巴细胞毒性试验(CDC)比较,差异有统计学意义(均为P < 0.05)。DGF组血NGAL在术后2周内均高于IGF组(均为P < 0.05);DGF组Cys-C、Scr、尿NGAL在术后3周内均高于IGF组(均为P < 0.001)。血NGAL、尿NGAL、Cys-C和Scr对肾移植受者发生DGF具有一定预测价值,其中Cys-C预测价值最高,截取值为4.73 mg/L,灵敏度为0.833,特异度为0.812,曲线下面积(AUC)为0.895。  结论  Cys-C早期预测肾移植受者发生DGF的价值高于血NGAL、尿NGAL及Scr。

     

  • 图  1  两组肾损伤标志物的变化趋势

    注:与IGF组比较,aP < 0.05。

    Figure  1.  Change trends of kidney injury markers in two groups

    图  2  肾损伤标志物预测DGF的ROC曲线

    Figure  2.  ROC curves of kidney injury markers in predicting DGF

    表  1  两组受者一般资料比较

    Table  1.   Comparison of general data of recipients between the two groups

    变量 DGF组(n=42) IGF组(n=117) P
    受者资料
      年龄(x±s,岁) 44±10 42±10 0.169
      性别[n(%)] 0.853
        男 26(62) 75(64)
        女 16(38) 42(36)
      BMI(x±s,kg/m2 23±4 22±3 0.267
      原发病[n(%)] 0.951
        慢性肾小球肾炎 7(17) 25(21)
        IgA肾病 5(12) 14(12)
        局灶硬化肾小球肾炎 1(2) 4(3)
        多囊肾 1(2) 5(4)
        高血压肾病 5(12) 10(9)
        糖尿病肾病 3(7) 5(4)
        其他 20(48) 54(46)
      血型[n(%)] 0.211
        A型 10(24) 34(29)
        B型 10(24) 41(35)
        AB型 5(12) 14(12)
        O型 17(40) 28(24)
      透析类型[n(%)] 0.084
        腹膜透析 9(21) 39(33)
        血液透析 32(76) 71(61)
        其他 1(2) 7(6)
      透析时间[MP25, P75),月] 36(18, 75) 24(9, 60) 0.055
      移植前Scr(x±s,μmol/L) 939±249 957±300 0.732
    供者资料
      年龄(x±s,岁) 44±10 39±9 0.007
      捐献前Scr[MP25, P75),μmol/L] 112(67, 171) 91(75, 115) 0.096
      供肾冷缺血时间(x±s,h) 15±5 12±4 0.001
    配型情况
      CDC(x±s,%) 2.9±0.9 2.5±0.6 0.015
      HLA错配数(x±s,个) 4.3±0.8 4.1±1.0 0.428
      PRA阴性[n(%)] 42(100) 117(100) 1.000
    免疫诱导方案[n(%)] 1.000
      ATG 19(45) 52(44)
      巴利昔单抗 23(55) 65(56)
    免疫抑制方案[n(%)] 0.798
      他克莫司 37(88) 100(86)
      环孢素 5(12) 17(14)
    下载: 导出CSV

    表  2  肾损伤标志物预测DGF的价值

    Table  2.   Efficacy of kidney injury markers in predicting DGF

    指标 截取值 灵敏度 特异度 阳性预测值 阴性预测值
    血NGAL 658.7 ng/mL 0.786 0.598 0.413 0.886
    尿NGAL 837.6 ng/mL 0.738 0.803 0.574 0.895
    Cys-C 4.73 mg/L 0.833 0.812 0.614 0.931
    Scr 693 μmol/L 0.905 0.496 0.392 0.935
    下载: 导出CSV
  • [1] CANTARELLI C, CRAVEDI P. Criteria for living donation from marginal donors: one, no one, and one hundred thousand[J]. Nephron, 2019, 142(3): 227-232. DOI: 10.1159/000500498.
    [2] MICHALAK M, WOUTERS K, FRANSEN E, et al. Prediction of delayed graft function using different scoring algorithms: a single-center experience[J]. World J Transplant, 2017, 7(5): 260-268. DOI: 10.5500/wjt.v7.i5.260.
    [3] ROLAK S, DJAMALI A, MANDELBROT DA, et al. Outcomes of delayed graft function in kidney transplant recipients stratified by histologic biopsy findings[J]. Transplant Proc, 2021, 53(5): 1462-1469. DOI: 10.1016/j.transproceed.2021.01.012.
    [4] CHI J, MA Y, WENG FL, et al. Surface-enhanced Raman scattering analysis of urine from deceased donors as a prognostic tool for kidney transplant outcome[J]. J Biophotonics, 2017, 10(12): 1743-1755. DOI: 10.1002/jbio.201700019.
    [5] ALBERT C, ZAPF A, HAASE M, et al. Neutrophil gelatinase-associated lipocalin measured on clinical laboratory platforms for the prediction of acute kidney injury and the associated need for dialysis therapy: a systematic review and Meta-analysis[J]. Am J Kidney Dis, 2020, 76(6): 826-841. DOI: 10.1053/j.ajkd.2020.05.015.
    [6] BARGNOUX AS, BARGUIL Y, CAVALIER E, et al. Estimation of glomerular filtration rate using cystatin C[J]. Ann Biol Clin (Paris), 2019, 77(4): 375-380. DOI: 10.1684/abc.2019.1456.
    [7] ZHOU SM, ZHAO W, LIN T, et al. Serum cystatin C can detect impaired graft function early after renal transplantation[J]. Int J Clin Exp Med, 2015, 8(9): 16379-16383. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659049/pdf/ijcem0008-16379.pdf
    [8] HU XJ, ZHENG J, LI Y, et al. Prediction of kidney transplant outcome based on different DGF definitions in Chinese deceased donation[J]. BMC Nephrol, 2019, 20(1): 409. DOI: 10.1186/s12882-019-1557-x.
    [9] KIM GH, PARK TH, CHOI JY, et al. Analysis of clinical outcomes according to the definition of slow graft function in deceased donor kidney transplantation[J]. Transplant Proc, 2019, 51(8): 2587-2592. DOI: 10.1016/j.transproceed.2019.03.066.
    [10] MA YC, ZUO L, CHEN JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J]. J Am Soc Nephrol, 2006, 17(10): 2937-2944. DOI: 10.1681/ASN.2006040368.
    [11] LI F, HU L, ZHAO X, et al. The value of cystatin C and urinary and serum neutrophil gelatinase-associated lipocalin during the perioperative period of renal transplantation[J]. Transl Androl Urol, 2019, 8(5): 432-441. DOI: 10.21037/tau.2019.08.12.
    [12] WANG Y, JIA Y, WANG C, et al. Urinary neutrophil gelatinase-associated lipocalin rapidly decreases in the first week after kidney transplantation[J]. J Clin Lab Anal, 2020, 34(10): e23445. DOI: 10.1002/jcla.23445.
    [13] TANG Z, TAO J, SUN L, et al. Prospective comparison of equations based on creatinine and cystatin C for the glomerular filtration rate estimation in Chinese renal transplant recipients[J]. Transplant Proc, 2018, 50(1): 85-91. DOI: 10.1016/j.transproceed.2017.12.004.
    [14] BAKER RJ, MARK PB, PATEL RK, et al. Renal association clinical practice guideline in post-operative care in the kidney transplant recipient[J]. BMC Nephrol, 2017, 18(1): 174. DOI: 10.1186/s12882-017-0553-2.
    [15] BENTATA Y. Tacrolimus: 20 years of use in adult kidney transplantation. what we should know about its nephrotoxicity[J]. Artif Organs, 2020, 44(2): 140-152. DOI: 10.1111/aor.13551.
    [16] HOŠKOVÁ L, MÁLEK I, KOPKAN L, et al. Pathophysiological mechanisms of calcineurin inhibitor-induced nephrotoxicity and arterial hypertension[J]. Physiol Res, 2017, 66(2): 167-180. DOI: 10.33549/physiolres.933332.
    [17] ZHANG H, FU Q, LIU J, et al. Risk factors and outcomes of prolonged recovery from delayed graft function after deceased kidney transplantation[J]. Ren Fail, 2020, 42(1): 792-798. DOI: 10.1080/0886022X.2020.1803084.
    [18] DAMODARAN S, BULLOCK B, EKWENNA O, et al. Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation[J]. Int Urol Nephrol, 2021, 53(3): 439-446. DOI: 10.1007/s11255-020-02687-5.
    [19] 李馨, 孙泽家, 蔡继飞, 等. DCD供肾灌注液生物标志物预测肾移植术后移植物功能延迟恢复的临床应用研究[J]. 器官移植, 2021, 12(2): 209-214. DOI: 10.3969/j.issn.1674-7445.2021.02.012.

    LI X, SUN ZJ, CAI JF, et al. Clinical application of biomarkers in DCD donor kidney perfusate for predicting delayed graft function after renal transplantation[J]. Organ Transplant, 2021, 12(2): 209-214. DOI: 10.3969/j.issn.1674-7445.2021.02.012.
    [20] GOLDFARB DA. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation[J]. J Urol, 2011, 185(5): 1826-1827. DOI: 10.1016/j.juro.2010.12.075.
    [21] SLORT PR, OZDEN N, PAPE L, et al. Comparing cystatin C and creatinine in the diagnosis of pediatric acute renal allograft dysfunction[J]. Pediatr Nephrol, 2012, 27(5): 843-849. DOI: 10.1007/s00467-011-2073-9.
    [22] HOŠKOVÁ L, FRANEKOVA J, MÁLEK I, et al. Comparison of cystatin C and NGAL in early diagnosis of acute kidney injury after heart transplantation[J]. Ann Transplant, 2016, 21: 329-245. DOI: 10.12659/aot.896700.
    [23] CAO J, LU X, GAO F, et al. Assessment of neutrophil gelatinase-associated lipocalin as an early biomarker for canine renal ischemia-reperfusion injury[J]. Ann Transl Med, 2020, 8(22): 1491. DOI: 10.21037/atm-20-6314.
    [24] POLIDORI N, GIANNINI C, SALVATORE R, et al. Role of urinary NGAL and KIM-1 as biomarkers of early kidney injury in obese prepubertal children[J]. J Pediatr Endocrinol Metab, 2020, 33(9): 1183-1189. DOI: 10.1515/jpem-2020-0138.
    [25] SHANG W, WANG Z. The update of NGAL in acute kidney injury[J]. Curr Protein Pept Sci, 2017, 18(12): 1211-1217. DOI: 10.2174/1389203717666160909125004.
    [26] BUONAFINE M, MARTINEZ-MARTINEZ E, JAISSER F. More than a simple biomarker: the role of NGAL in cardiovascular and renal diseases[J]. Clin Sci (Lond), 2018, 132(9): 909-923. DOI: 10.1042/CS20171592.
    [27] LUMLERTGUL N, AMPRAI M, TACHABOON S, et al. Urine neutrophil gelatinase-associated lipocalin (NGAL) for prediction of persistent AKI and major adverse kidney events[J]. Sci Rep, 2020, 10(1): 8718. DOI: 10.1038/s41598-020-65764-w.
    [28] SIDDAPPA PK, KOCHHAR R, SAROTRA P, et al. Neutrophil gelatinase-associated lipocalin: an early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis[J]. JGH Open, 2018, 3(2): 105-110. DOI: 10.1002/jgh3.12112.
  • 加载中
图(3) / 表(2)
计量
  • 文章访问数:  407
  • HTML全文浏览量:  236
  • PDF下载量:  125
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-09-03
  • 网络出版日期:  2022-01-12
  • 刊出日期:  2022-01-15

目录

    /

    返回文章
    返回